William Cayley: What are the (hidden) costs?

bill_cayley_2“The economics of education are changed dramatically by delivering online courses to large numbers, making expensive education much cheaper.” That line in Richard Smith’s blog post describing a proposed “global university” for healthcare workers caught my attention—especially since my own local statewide university system, of which I am an employee as a medical school faculty member, is facing a proposed $300 million budget cut over the next two years.

Of course, my selfish side thinks of the proposed funding cut in terms of the direct impact on me—and I don’t want to see our program, our department, or our medical school adversely affected. My more reflective side, however, ponders why some feel the cuts are appropriate in the first place.

There is of course the whole area of debate over how much public entities should fund education—and higher education in particular. Without getting into that thorny area, I do wonder at the continually skyrocketing costs of all levels of education, and whether they are in part owing to our penchant for “needing” or depending on more and more advanced or tech-dependent ways of doing things in all spheres of life.

Don’t get me wrong, I’m glad for modern conveniences. Our furnace has been acting up the last few days, and with temperatures as low as -25 C over the last weekend, I appreciate even more the value of a dependable, modern furnace. Nevertheless, there are some things that seem to be now taken for granted as “essential” parts of modern life, which leave me wondering if they cost more than they are worth:

• An easy target here is smartphones with continual internet access. As I see people around me posting to Facebook, or checking email, or looking at Google maps from their “smart” devices, I wonder about the cost of the monthly data plan needed to maintain that access. Our family has specifically decided not to use smartphones for now, precisely because of the added monthly cost the data charges would bring. It’s much cheaper to buy a “real” paper map, than have continual access to Google.

• In the educational realm, it’s hard to escape noticing (at least in “first world” or so called “developed” countries) the continual proliferation of technology in teaching. Computers and iPads are ever more a part of daily life in schools. While I can certainly see some benefits to the connectivity, the creative options (for example, making in class videos), and the teaching apps that these offer, I wonder if the added cost this technology brings is really worth the benefit provided.

• It is common to bemoan the growing influence of electronic medical records (EMRs) in medicine, but I’ll admit I do find some features of ours a clear improvement over older paper methods. Still, EMRs are expensive: the hardware is costly, the software is costly, and someone has to pay for all those tech support people. Here, again, are the benefits TRULY worth the costs?

My concern in all three areas is not with the benefits technology provides, nor do I want to only do things as cheaply as possible. I do wonder, however, how much we are unwittingly and implicitly depending on more and more expensive ways of doing things, in part because of a disconnect between use and payment.

The conundrum here (and perhaps the inconsistency in my thinking? Ah, well . . . ) is that the proposed global university is only possible with today’s internet technology.

So, I’m not proposing a Luddite rejection of all things techie, and I certainly don’t want to oppose creative innovation. Rather, perhaps the point is that those of us in the “developed” world need to look to those in the “less developed” world for lessons on how to use our resources for innovation more wisely.

(An aside—perhaps I have my terms wrong. Rather than talking about the “developed” and the “less developed” parts of the world, perhaps the better terms are the “expensive” part of the world and the “creative” part of the world. An interesting economic piece in World Development last year found that in comparison to other parts of the world, “Once geography, political competition, and the business environment are controlled for, formal African firms lead in productivity levels and growth.”)

I sincerely hope that the global university takes off, and I also hope our own university deals with adverse budget circumstances well. Mostly, though, I hope that every one of us who makes decisions about what programs to propose, what technologies to introduce, or what conveniences to use, will think seriously about whether the benefits truly are worth the overt and sometimes covert costs.

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.

Read The BMJ‘s analysis article: Too much technology